The purpose of this cooperative agreement is to strengthen the capacity of the Programme Nationale de Transfusion Sanguine (PNTS) so that the Government of the DRC (GDRC) can assure a safe and adequate blood supply for its population, particularly pregnant women, children, trauma victims, and other populations susceptible to contracting HIV and other blood-borne pathogens through blood transfusions. The PNTS was established in 1999 by the Ministry of Health with the mandate to coordinate all activities and services related to blood transfusion and blood products, including screening and safety. The scope of PNTS' work includes the collection and use of strategic information, capacity building among health professionals involved in blood and blood product services, strengthening of laboratory capacity at local, provincial and national levels, and formulating and revising policy documents.

PNTS will implement activities in the following areas: lab infrastructure, blood collection, blood testing, transfusion and blood utilization, training, and monitoring and evaluation. The majority of activities implemented will occur at the central level; however, some activities deal with strengthening laboratory capacity in PEPFAR-supported areas through training of staff, provision of necessary reagents and laboratory and blood collection equipment, and implementation of quality assurance procedures will occur at the provincial or district levels in areas currently supported by PEPFAR. The quality assurance system that will be put in place will be a joint system used by the Nationals AIDS Control Program (PNLS), the National TB Program (PNT), the Kinshasa School of Public Health (KSPH), as well as the PNTS, and developed with technical assistance from Association of Public Health Laboratories (APHL).

PNTS will dedicate portions of the total budget to human resources for health and construction/renovation through in-service training of laboratory technicians and clinical healthcare workers involved in blood transfusion as well as ensuring the blood banks, laboratories, and general hospitals have the capacity to collect, test, store, and give blood products. The money allocated by PNTS for construction/renovation refers to the renovation of a counseling center at the PNTS to use to counsel potential blood donors.

PNTS will develop basic program evaluation tools and operational research protocols to improvement program effectiveness and perform monitoring and evaluation throughout the cooperative agreement in order to assess the progress of each activity, as well as a system for reviewing and adjusting program activities based on strategic information Measurement of clinical outcomes will be integrated into evaluation activities in order to assess the ultimate benefit to Congolese receiving blood transfusions, particularly pregnant women, children, survivors of trauma, and others at higher risk for contracting HIV or other blood borne pathogens from transfusions. Some of the activities funded will be formative evaluations and initial assessments of current services, gaps, and capacity of the health system, such as

an assessment of the blood transfusion system, including regional blood collection and processing facilities, testing equipment, and available supplies.

The HHS/CDC will continue ongoing technical assistance and mentorship towards the goal of sustainability through this cooperative agreement. As the DRC's PNTS gains capacity, it will be able to provide technical and public health assistance and policy guidance to indigenous NGOs, further strengthening the health system at various levels of governance in the DRC.

All activities will occur in USG-supported provinces only unless otherwise noted. Laboratory

infrastructure: PNTS will assess current lab infrastructure needs for a national, regionalized blood

transfusion system, including laboratory testing equipment and supplies; and provide standard blood

collection and laboratory equipment and reagents to regional collection facilities to collect blood and

perform necessary tests. Blood collection: PNTS will develop generic and site-specific protocols for

obtaining, handling, storing, transporting, and distributing blood for use in collection facilities; assess the

collection system developed by Safe Blood For Africa in the Kasai Province; develop and maintain a

network of blood donor recruiters and blood donor counselors to operate from each provincial center; and

develop and maintain a system to identify a network of low-risk and repeat blood donors for possible

expansion in other USG served provinces. Blood testing: PNTS will develop national and site-specific

protocols for testing blood for HIV, hepatitis, and syphilis; manage blood testing facilities, ensuring good

recordkeeping; and implement effective quality assurance (QA) procedures for testing blood.

Transfusion and blood utilization: PNTS will implement national guidelines developed by USG for the

appropriate use of blood and blood products; and develop blood utilization review and QA systems for

blood usage. Training: PNTS will develop and provide training programs and continuing education

programs on blood collection and donor recruitment for health and para-health professionals involved

with blood transfusion services; develop and provide training programs and continuing education

programs for physicians and laboratory technicians in basic principles and practices of blood banking and

transfusion medicine; and develop educational programs that recognize community norms for healthcare

providers, nurses, and the general public on safe transfusion practices and reducing the demand for

unnecessary transfusions. Monitoring and evaluation: in addition to M&E procedures discussed in the

general narrative, PNTS will develop and implement best practice guidance at the district level.